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J Diabetes Complications. 2015 Jan-Feb;29(1):20-5. doi: 10.1016/j.jdiacomp.2014.09.006. Epub 2014 Sep 16.

Is depression a risk factor for diabetic foot ulcers? 11-years follow-up of the Nord-Trøndelag Health Study (HUNT).

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Faculty of Health and Social Sciences, Bergen University College, PO Box 7030, N-5020 Bergen, Norway; Department of Endocrinology, Stavanger University Hospital, PO Box 8100, 4068 Stavanger, Norway. Electronic address:
Department of Global Public Health and Primary Care, University of Bergen, PO Box 7800, 5020 Bergen, Norway.
Faculty of Health and Social Sciences, Bergen University College, PO Box 7030, N-5020 Bergen, Norway.
The HUNT Research Center, Norwegian University of Science and Technology, Forskningsveien 2, 7600 Levanger, Norway.
Duke Global Health Institute, Duke University, Box 90519 Durham, NC 27708, USA.



To prospectively examine whether depressive symptoms increase the risk of diabetes and a diabetic foot ulcer.


The Nord-Trøndelag Health Study (HUNT) is a community-based longitudinal study. The Hospital Anxiety and Depression Scale (HADS-D subscale) assessed depressive symptoms. We followed individuals with complete HADS-D data from HUNT2 (1995-97) and assessed whether they reported diabetes with or without a history of diabetic foot ulcer (DFU) in HUNT3 (2006-08) (n=36,031). Logistic regression was used to investigate the effect of depressive symptoms on subsequent development of diabetes and of DFU.


Unadjusted odds for reporting diabetes at follow-up was higher among individuals who reported a HADS-D score≥8 at baseline (OR 1.30 95% CI, 1.07-1.57) than among those reporting a lower score. After adjusting for age, gender and BMI, this association was no longer significant. The odds of developing a DFU was almost two-fold (OR=1.95 95% CI, 1.02-3.74) for those reporting a HADS-D score of 8-10, and 3-fold (OR=3.06 95% CI, 1.24-7.54) for HADS-D scores≥11, compared to HADS-D scores<8, after adjusting for age, gender and serum glucose.


Symptoms of depression at baseline are associated with an increased risk of a diabetic foot ulcer in a dose response manner during this 11-year follow-up.


Cohort study; Depression; Diabetes; Foot ulcer; Norway; Risk factor

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